Method for the automated and assisted acquisition of anatomical surfaces

ABSTRACT

The method for the automated and assisted acquisition of anatomical surfaces includes a first acquisition of the surfaces undertaken in order to create a first numerical model and a perioperative second acquisition undertaken by scanning the surfaces in order to create a second numerical model for identifying the coordinates of the surfaces. The surfaces are supported by a robotic arm; and then the models are brought into correspondence by resetting. The scanning in the second acquisition includes making a preliminary identification of the coordinates of noteworthy points on the surfaces manually, assisted by the robotic arm, and the identifying parts a the points, in order to construct a reference frame and to determine a scanning region; creating an intermediate model from the reference frame and at least one of the points; preliminary resetting the first model with the second model; and automatically scanning the determined zone.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.13/810,186, filed Jan. 14, 2013, which application is the national phaseunder 35 USC 371 of International Application No. PCT/FR2011/051747,filed Jul. 20, 2011, which application claims priority to French PatentApplication No. 1056428, filed Aug. 4, 2010, all of which are hereinincorporated by reference.

BACKGROUND OF THE INVENTION 1. Field of the Invention

The present invention is related to the medical field, in particular inoperative methodology during the preparation and carrying out ofsurgical interventions.

The invention relates in particular to medical imaging and, in theperioperative phase, to the automated acquisition of anatomicalsurfaces, in particular of a patient's head and face, then the surfaceresetting of the acquired images with respect to images stored inpre-operative phase.

The invention will find an application in the assistance by robotics forthe acquisition of anatomical surfaces and for the surface resetting.

To this end, the present invention relates to a method for automated andassisted acquisition of anatomical surfaces.

2. Description of Related Art Including Information Disclosed Under 37CFR 1.97 and 37 CFR 1.98

In a known way, during a surgical operation on a patient, in particularwithin the framework of the neurosurgery at the level of a patient'shead, the doctor uses systems providing an assistance, in particular byimproving the surgical accuracy. To this end, such systems permit, inthe perioperative phase, the acquisition of the anatomical surfacesaimed by the operation, then their resetting with respect to imagesalready recorded, for example previously, during a pre-operative phaseduring an X-ray examination (CT-scan) or an MRI (stands for MagneticResonance Imaging). It is thus possible for the doctor to accuratelylocalize the patient with respect to the imaging for the operation.

In particular, the acquisition consists in identifying the actualposition of the patient's anatomical zone, by performing a scanning ofthe surface of said zone using a pointer, for example in the form of amechanical point, ultrasonic waves or a laser beam. The system thenperforms a surface resetting in the form of a comparison between thisidentification and the images recorded previously in the pre-operativephase, calculating the bringing into correspondence of the existingimages with the patient's body at the time of the operation. In brief,for each identified point, an evaluation is performed so as to cause theacquired scatter diagram to correspond to the pre-recorded images.

Therefore, the way of performing the step of acquisition of theanatomical surfaces has a considerable influence on the accuracy of theoperation that will follow. Several acquisition systems exist nowadays,which use different techniques for identifying the anatomical surfaces.

A first solution consists in positioning, at different particular placesof the zone to be acquired, markers, in the form of a mask or pads,directly glued on the skin. These markers are then identified in thespace by scanning with a mechanical point or a transmission/receivingbeam, namely a laser.

The main drawback of such a scanning resides in its lack of accuracy,which depends on the way of localizing said markers as well as theirnumber and their spatial distribution on the skin. The resettingresulting from the same is then little reliable, i.e., it exhibitsimportant variations and shifts at the level of the surfaces locatedbetween the markers.

In addition, the markers can move, because of the elasticity of theskin, even detach. The placing of the markers also obliges to shave theportion of the cranium.

An alternative solution consists in passing over the anatomical zonewith a pointer, the coordinates of which are located in the space, inparticular through cameras.

According to an embodiment, said pointer can be mechanical, being in theform of a probe, the point of which enters directly into contact withthe skin. Said point is manually displaced from one point to another,namely on the morphologically noteworthy points, and along particularanatomical lines of the zone involved, while its different positions andcontact points are recorded in three dimensions.

However, though this technique permits to identify a larger number ofpoints of the surface, it remains limited as to the number of pointsidentified, about one hundred, requiring a restriction of theidentification to determined lines and determined noteworthy places ofthe patient's anatomy. This restriction, due to the intervention by theoperator, has automatically an influence on the quality of thesubsequent surface resetting. Furthermore, the deformation of the skinduring the scanning with the pointer is another cause for inaccuracy.

An alternative resides in a contactless pointer, permitting to obtain alarger number of points identified in a smaller period of time. Such apointer is in the form of a light-radiation transmitter, such as a laserbeam. Said transmitter is held in hand by the practitioner, who scansthe anatomical zone with the laser.

A first known device comprises a transmitter in the form of a lasertelemeter, the position and the orientation of which are constantlyidentified in the space, permitting to obtain the coordinates of eachpoint recorded by the telemeter.

However, the accuracy of the identification by the telemeter remainslimited. That is why it has been devised to directly record the impactof the emitted laser beam at the level of the skin. To this end, thetransmitter transmits, on the one hand, a laser beam in the visiblelight spectrum, in order to allow the practitioner to display the pointof impact and its scanning of the patient's anatomical zone and, on theother hand, a beam of invisible light, such as the infrareds, which arecaptured by specific sensors. Specifically, the reflection of theinfrareds at the point of impact permits to accurately identify theposition of said point in the space.

It should be noted that the localization of the telemeter or the pointof impact of the laser beam uses an optical triangulation principleusing various cameras.

Despite these various evolutions, the existing identification andscanning systems are not completely satisfactory.

Indeed, the scanning always occurs manually, creating a human factor,which reduces the accuracy of the identification, but also itsrepeatable nature, i.e., the scanning paths remain approximate andcompletely related to the practitioner.

In order to cope with these drawbacks, it has been devised to couple thetransmitter to a robot. Such solutions are described in WO 2009/013406,WO 2005/122916 and WO 2005/032390.

In particular, the transmitter is fixed to the end of a robotized arm,hinged so as to have degrees of freedom of movement in the threedimensions. The position of the transmitter and the data it records arethen identified in the space with respect to the reference system ofsaid robotized arm.

In particular, a first previous acquisition of said anatomical surfacesis performed, so as to create a three-dimensional representation in theform of a first digital model; then, a second perioperative acquisitionby scanning said surfaces is performed, so as to create athree-dimensional representation in the form of a second digital model;then, said scanning is performed with means for identifying thecoordinates of said surfaces, said means being supported by a robotizedarm; and finally a bringing into correspondence by resetting said firstand second models is performed.

Therefore, one observes that the resetting of the models is not optimal,requiring the intervention of a data-processing operator, in order totry to cause the models to match. When this fails, it is necessary torepeat the scanning operation, increasing that more the duration of theintervention.

In addition, even though such devices permit to avoid depending from theoperator, by automating the scanning of the anatomical surface, with ahighly reproducible nature, this automation considerably limits thecapabilities of adaptation of these devices with respect to theanatomical zone, in particular with respect to the differentmorphologies of the patients.

Furthermore, in all cases the existing devices use means for navigatingwithin the display of the three-dimensional digital model obtained fromthe images so acquired. These navigation means necessarily require theidentification of the transmitter, as previously evoked, thereafter ofthe surgical instruments.

SUMMARY OF THE INVENTION

The aim of the invention is to cope with the drawbacks of the state ofthe art by providing a method for automated and assisted acquisition ofanatomical surfaces, which combines the accuracy of a scanning assistedby a robotized arm with the adaptability of a manual scanning, whilepermitting the acquisition of a large number of points.

In particular, the invention foresees to perform a preliminary scanningmanually controlled by the practitioner, with a transmitter supported bysaid robotized arm, permitting, on the one hand, to determine a specificzone for a subsequent fully automated scanning and, on the other hand,to perform a first surface resetting increasing the accuracy of thefinal surface resetting.

To this end, in such a method:

-   -   a first previous acquisition of said anatomical surfaces is        performed, so as to create a three-dimensional representation in        the form of a first digital model;    -   a second perioperative acquisition by scanning said surfaces is        performed, so as to create a three-dimensional representation in        the form of a second digital model;    -   said scanning being performed with means for identifying the        coordinates of said surfaces, said means being supported by a        robotized arm;    -   then    -   a bringing into correspondence by resetting said first and        second models is performed.

Said method is characterized in that the scanning consists of:

-   -   performing a preliminary identification of the coordinates of        the noteworthy points of said anatomical surfaces by manual        displacement, assisted by said robotized arm, of said means for        identifying at the level of said noteworthy points, so as to        construct a reference frame and to determine a scanning zone for        said anatomical surfaces;    -   creating an intermediate model from said reference frame and at        least one of said noteworthy points;    -   performing a preliminary resetting of said first model with said        second model;    -   performing an automatic scanning of the determined zone.

Thus, the method according to the invention provides an increasedaccuracy in the scanning being performed and the identification of alarger quantity of anatomical points of the zone involved, with anautomated and reproducible accuracy of the path, while adding a manualand adaptable nature through the initial manipulation by an operator.

Another advantage of the present invention resides in the use of arobotized arm, which then serves as a reference frame. The anatomicalzone to be scanned, then the model extracted from this acquisition arelocalized with respect to this reference frame, so that thereafter,after resetting, the same reference frame of the robotized arm servesfor positioning the surgical instruments for the operation.

According to other features, said method consists of:

-   -   performing an identification of the coordinates of at least        three noteworthy points;    -   determining a fourth point from one of said three noteworthy        points by symmetry according to an axis passing through the        other two of said noteworthy points; and    -   determining a reference frame for calculating the path of the        automatic scanning, said reference frame being formed of at        least two axes, each comprising a pair of said four noteworthy        points.

Advantageously, said method consists of performing an identification ofthe coordinates of at least one central point, said central point beinglocated at the intersection of said axes.

According to one embodiment, the method consists in recording saidcentral point at the level of the first model; and in that saidpreliminary resetting is performed by bringing into correspondence thecentral point with at least another noteworthy point.

According to another embodiment, it consists in performing the bringinginto correspondence of said first model with said intermediate model bymatching said axes.

According to the preferred application, said anatomical surfacescorrespond to the face and said axes follow at least partially the noserim and a frontal line.

According to another facultative feature, the method consists indetermining a reference frame centered on said robotized arm.

Further features and advantages of the invention will become clear fromthe following detailed description of the non-restrictive embodiments ofthe invention, with reference to the attached figures.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1, 2 and 3 represent a schematic front view of three steps of themethod according to the invention applied to a patient's face.

FIG. 4 schematically represents a detailed schematic view of thepossibility of the automatic scanning step according to the invention.

FIGS. 5, 6 and 7 schematically represent three views of e surfaceresetting of the method according to the invention.

DETAILED DESCRIPTION OF THE DRAWINGS

The present invention relates to a method for automated and assistedacquisition of anatomical surfaces.

Specifically, such a method combines a manual intervention with arobotic assistance, then a fully automatic robotized operation.

It should be noted that the anatomical surfaces in the meaning of theinvention can comprise any portion of a patient's body. According to theexample shown in the figures, according to the preferred embodiment,said anatomical surfaces correspond to the face 1 of said patient.

In a first step, prior to the operation, a first previous acquisition ofsaid anatomical surfaces of the patient is performed. Such a previousacquisition can be obtained by any kind of means, in particular througha scanner or an IRM.

From this previous acquisition, a three-dimensional representation inthe form of a first digital model 2 is created.

Then, in the perioperative phase, a second acquisition is performed byscanning of said anatomical surfaces. From this second acquisition, athree-dimensional representation in the form of a second digital model 3is created.

Finally, a bringing into correspondence by surface resetting of saidthus obtained first 2 and second 3 models is performed. In brief, asuperposition of said models 2 and 3 is performed in order to cause bothrepresentations to coincide, the second model 3 covering said firstmodel 2.

This resetting step is represented in FIGS. 5 to 7, FIG. 5 representingthe second model 3, while FIGS. 6 and 7 represent the superposition ofsaid second model 3 on the first model 2, according to a profile viewand a front view of the anatomic surface involved, i.e. a patient'shead, respectively.

In particular, said resetting can be based on an algorithm for resettingthree-dimensional data, referred to as ICP (stands for <<iterativeclosest point>>). Generally, the ICP algorithm consists in iterativelycalculating the rigid transformation matrix (rotation and translation)resetting in the best way two sets of data defined by their coordinatesin a three-dimensional identification.

Advantageously, an essential feature of the present invention resides inthat said scanning is performed by means for identifying the coordinatesof said anatomical surfaces.

In particular, these identification means cam measure in the space anddetermine the coordinates of points of said surfaces with respect to areference system.

Preferably, said identification means are supported by a robotized arm.The latter is designed movable and controlled so as to provide it withdegrees of freedom of movement according to the three dimensions.Therefore, said reference system, with respect to which the coordinatesof the points of said anatomic surface are measured, is determined bysaid robotized arm.

It should then be noted that the patient is immobilized with respect tothe base on which said robotized arm rests and moves.

In this respect, said robotized arm serves as a reference frame, duringthe acquisition, but also for the subsequent further operations.

In particular, the data-processing means and the calculator associatedwith said robotized arm permit to centralize the spatial identificationof the patient's body, but also of the tools necessary for theacquisition and the scanning of the anatomical surfaces, as thetransmitter positioned at the end of said arm, but also for the surgicaltools that will intervene in the operative phase.

Therefore, this reference frame permits to reset the information and thecoordinates of the patient, of the points, but also of the acquisitionand surgery tools, with respect to the pre-operative imaging.

In brief, the robotized arm provides a unique reference systempermitting to identify and coordinate in the space, in real time, thevarious above-mentioned elements. Indeed, the <<modeled chain>> formedby the immobility of the patient's body with respect to the base of therobotized arm, as well as the arm itself until the end of the tool itcarries, is sufficient per se to ensure an identification of each of theelements it is comprised of within a reference frame in the space. Inorder to achieve such a result, it is necessary to initialize such achain, namely by identifying the elements it is comprised of. Such aninitialization operation can be performed prior to the acquisition andduring the latter, hut also subsequently and during the intervention,through steps of updating of said chain. These updating operations occurautomatically depending on the positioning of the tools and elementsused, integral with said robotized arm.

Therefore, a repeatable nature intervenes in the positioning anddisplacement of the tools and elements, while this reproducible aspectcould not be contemplated during the fully manual work of apractitioner, making them operator-dependent.

Furthermore, it is also possible to make the patient's body independentfrom the robotized arm and from its base. Therefore, an acquisition ofthe position of said patient should be performed in real time, in orderto know exactly the changes in same, in order to get adapted to them.

Finally, the end of the robotized arm can also simultaneously carrymeans necessary for the acquisition and tools for the intervention.Indeed, it is then possible to contemplate, through miniaturizedelements and tools, to integrate localization technologies, such as alaser, ultrasounds, a camera, mechanical tools or elements of surface orpercutaneous telemetry coupled to tools, namely surgical tools. It isthen possible to know in real time the positioning and the displacementof any of these elements, permitting an automation of the movements andpaths of each of them, combined with acquisitions and three-dimensionalsurface resetting operations.

According to one embodiment, said identification means can be designedcontactless, namely in the form of a radiation transmitter, for examplea light transmitter, such as a laser beam, coupled to a distance sensor.In particular, said identification means can be in the form of a lasertelemeter.

Other transmitters can be contemplated, using optical beams, acousticwaves, such as the ultrasounds or radio waves.

Thus, such identification means, located at the movable end of saidrobotized arm, can move around the anatomical surfaces to be scanned.

In this respect, an essential feature of the invention resides in thatthe scanning is divided into two successive steps.

A first step of the scanning consists of performing a preliminaryidentification of the coordinates of noteworthy points of saidanatomical surfaces by manual displacement, assisted by said robotizedarm, of said identification means at the level of said noteworthypoints. This preliminary identification permits to determine a zone forscanning said anatomical surfaces.

In brief, the practitioner himself controls the displacement of theidentification means, still integral with said robotized arm, in orderto position them and to measure the coordinates of the specific pointsof the anatomical surfaces.

This step is operator-dependent, but sufficiently simple to beimplemented in order to ensure a satisfactory reproducibility andaccuracy of the coordinates of said noteworthy points.

The second step consists in performing an automatic scanning of the zonedetermined by said noteworthy points, by means of the robotized armalone.

Thus, the manual identification permits to improve the automaticscanning by marking and delimiting the zone within which the coordinateswill be measured, increasing the accuracy, limiting the risks ofextrapolation and providing a capability of adapting the invention tothe various morphologies of the anatomical surfaces.

According to a particular embodiment, said manual identification recordsthe coordinates of at least three noteworthy points among 4, 5, 6 or 7in order to construct a reference frame. A fourth point can bedetermined by symmetry with respect to three other points alreadytargeted. In particular, in the case of a face, said fourth point can beobtained from one of said three noteworthy points by symmetry withrespect to an axis passing through the other two of said noteworthypoints. Further noteworthy intermediate points can be identifiedmanually by the practitioner, depending on the cases and the morphologyof the anatomical surfaces involved.

Then, a reference frame for calculating the path of the automaticscanning is determined, said reference frame being formed by at leasttwo axes A-A′ and B-B′, each comprising a pair 4,5 and 6,7 of said fournoteworthy points.

In the exemplary implementation shown in FIGS. 1 to 3, said anatomicalsurfaces correspond to the face 1. In addition, said axes A-A′ and B-B′follow at least partially the nose rim and a frontal line, respectively,the nose rim being substantially vertical, while the frontal line issubstantially horizontal. Said noteworthy points can then correspond:for point 4 to the center of the forehead, for point 5 to the end of thenose bone, and for point 6 to a point of the left end of the forehead,while point 7 corresponds to the opposite end.

It should be noted that the points 4 and 5 determine the height of thezone to be scanned, while the points 6 and 7, located on each side ofthe face 1, permit to determine the width of said zone.

In addition, the invention foresees to perform a first bringing intocorrespondence with the help of said thus defined frame.

To this end, the invention consists in performing an identification ofthe coordinates of at least one central point 8. In particular, saidcentral point 8 is located at the intersection of said axes A-A′ andB-B′.

Said central point 8 will serve as a center, in order to perform thispreliminary surface resetting.

To reach this, said central point 8 should be recorded at the level ofthe first model 2, i.e. on the imaging performed before the operation.

Then, a three-dimensional intermediate representation in the form of adigital intermediate model is created. In brief, this intermediate modelcan include any of the noteworthy points 4 to 7, as well as the centralpoint 0 and/or the axes A-A′ and B-B′.

Afterwards, a bringing into correspondence is performed through apreliminary resetting of said first model 2 with said intermediatemodel, by bringing into correspondence said central point 8 and at leastanother noteworthy point 4 to 7. This intermediate bringing intocorrespondence can also be performed by means of said so definedreference frame, by correspondence of said axes A-A′ and B-B′.

This pre-resetting thus permits to more efficiently adjust the models 1and 2 during the final resetting.

Said preliminary resetting (and the associated data-processingcalculation time) can also intervene during the automatic scanning step.

In this respect, once the scanning zone has been determined, thescanning path is calculated in order to optimize the number and thedistribution of the points identified within said zone.

A non-restrictive exemplary path is schematically shown in FIG. 4. Oneobserves that the path follows the axis B-B′ from the point 6 towardsthe point 7, in the upper portion of the reference frame, then followssymmetrically the axis A-A′ from top to bottom, from the underside ofthe point 4 to the point 5.

It should be noted that in the example the displacement occurs in theform of a toothed and continuous path. However, any kind of displacementcan be contemplated, according to various continuous or discontinuouscurves adapted depending on the morphology of the anatomic zoneinvolved.

Furthermore, all the digital data in the meaning of the presentinvention (models, coordinates or algorithm) and their implementation(recording, modification or display) are processed through adapteddata-processing means. The same apply to the programming and the digitalcontrols of said robotized arm.

The method for contactless acquisition according to the inventionprovides a reliable and reproducible and methodology, quick and easy tobe implemented by any practitioner, for an accurate result, avoidingerrors related to the operator, while preserving an improvement thanksto the adaptability depending on the practitioner and his medicalexperience. In particular, the operator can correct the initial path,providing an intelligent and cooperative aspect, but also flexibilitywith the advantages provided by the strictness and precision of therobotic automatism.

Of course, the invention is not limited to the examples shown anddescribed above, which can have variants and modifications withouttherefore departing from the framework of the invention.

What is claimed is:
 1. A method for aligning a pre-operativethree-dimensional model to a perioperative coordinate system associatedwith a surgical robot, the method comprising: manually identifying aplurality of noteworthy points on an anatomical surface of a patientusing a scanning device coupled to an end effector of the surgicalrobot; constructing a reference frame based on the plurality ofnoteworthy points; computing an intermediate three-dimensional modelfrom the plurality of noteworthy points and the reference frame;resetting the reference frame based at least in part on bringing thepreoperative three-dimensional model into correspondence with theintermediate three-dimensional model; automatically scanning, using thescanning device, a scanning zone determined based on the reset referenceframe; computing a reference three-dimensional model from data collectedfrom the scanning zone with the scanning device; and aligning theperioperative coordinate system with the patient based on bringing thereference three-dimensional model into correspondence with thepre-operative three-dimensional model.
 2. The method of claim 1, whereinmanually identifying a plurality of noteworthy points includes manuallyscanning with the scanning device at least three noteworthy points onthe anatomical surface of the patient.
 3. The method of claim 2, whereincomputing the intermediate three-dimensional model includes determininga fourth noteworthy point from the at least three noteworthy pointsbased at least in part on a line of symmetry determined from two of theat least three noteworthy points.
 4. The method of claim 1, whereinmanually identifying the plurality of noteworthy points includesmanually manipulating a robotic arm holding the scanning device tocollect the noteworthy points.
 5. The method of claim 4, whereinautomatically scanning includes the robotic arm automatically moving thescanning device based at least in part on the intermediate referenceframe.
 6. The method of claim 1, wherein resetting the reference frameincludes computing at least two axes based on the plurality ofnoteworthy points, wherein the axes are used to guide the automaticscanning.
 7. The method of claim 6, wherein computing the at least twoaxes comprises using at least four noteworthy points including a firstnoteworthy point and a second noteworthy point forming a first axis anda third noteworthy point and a fourth noteworthy point forming a secondaxis.
 8. The method of claim 1, wherein resetting the reference frameincludes aligning the perioperative coordinate system to the referenceframe, and wherein a robotic arm operates within the perioperativecoordinate system to perform movements relative to the patient.
 9. Themethod of claim 8, wherein automatically scanning includes controlling,based at least in part on the reset reference frame, the robotic arm,and wherein the scanning device is coupled to an end effector of therobotic arm.
 10. The method of claim 9, further comprising using thescanning device to track position of a surgical instrument coupled tothe robotic arm within the perioperative coordinate system in referenceto the patient.
 11. The method of claim 10, further comprising updatingthe perioperative coordinate system in reference to the patient inreal-time based on data from the scanning device.
 12. A surgical robotsystem comprising: a robotic arm including an end effector; a scanningdevice couplable to the end effector; and a controller configured tocontrol the surgical robot to perform operations comprising: enablingmanual movement of the end effector to manually identify a plurality ofnoteworthy points on an anatomical surface of a patient using thescanning device; constructing a reference frame based on the pluralityof noteworthy points; calculating an intermediate three-dimensionalmodel from the plurality of noteworthy points and the reference frame;resetting the reference frame based at least in part on bringing thepre-operative three-dimensional model into correspondence with theintermediate three-dimensional model; automatically scanning, using thescanning device, a scanning zone determined based on the reset referenceframe; calculating a reference three-dimensional model from datacollected from the scanning zone with the scanning device; and aligninga perioperative coordinate system with the patient based on bringing thereference three-dimensional model into correspondence with thepre-operative three-dimensional model.
 13. The system of claim 12,wherein manually identifying a plurality of noteworthy points includesmanually scanning with the scanning device at least three noteworthypoints on the anatomical surface of the patient.
 14. The system of claim12, wherein calculating the intermediate three-dimensional modelincludes determining a fourth noteworthy point from the at least threenoteworthy points based at least in part on a line of symmetrydetermined from two of the at least three noteworthy points.
 15. Thesystem of claim 12, wherein resetting the reference frame includescomputing at least two axes based on the plurality of noteworthy points,wherein the axes are used to guide the automatic scanning.
 16. Thesystem of claim 15, wherein computing the at least two axes comprisesusing at least four noteworthy points including a first noteworthy pointand a second noteworthy point forming a first axis and a thirdnoteworthy point and a fourth noteworthy point forming a second axis.17. The system of claim 12, wherein resetting the reference frameincludes aligning the perioperative coordinate system to theintermediate reference frame, and wherein the robotic arm operateswithin the perioperative coordinate system to perform movements relativeto the patient.
 18. The system of claim 17, wherein automaticallyscanning includes controlling, based at least in part on theintermediate reference frame, the robotic arm.
 19. The system of claim18, further comprising using the scanning device to track position of asurgical instrument coupled to the robotic arm within the perioperativecoordinate system in reference to the patient.
 20. The system of claim19, further comprising updating the perioperative coordinate system inreference to the patient in real-time based on data from the scanningdevice.